Provider Demographics
NPI:1265784607
Name:PHILLIPS-LEWIS, BEVERLEY CHARMAINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:BEVERLEY
Middle Name:CHARMAINE
Last Name:PHILLIPS-LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BEVERLEY
Other - Middle Name:CHARMAINE
Other - Last Name:PHILLIPS-LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:32 HOBSON AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2506
Mailing Address - Country:US
Mailing Address - Phone:203-843-0162
Mailing Address - Fax:848-210-8173
Practice Address - Street 1:1 BRADLEY RD
Practice Address - Street 2:SUITE 905
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2285
Practice Address - Country:US
Practice Address - Phone:203-298-9005
Practice Address - Fax:203-298-9006
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0061161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical